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Endoscopic posterior cervical foraminotomy via a single stab incision for contiguous two-level cervical radiculopathy

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Abstract

Background

Endoscopic posterior cervical foraminotomy (EPCF) is an effective surgical treatment method for single-level cervical radiculopathy. However, only few studies have used the technique for two-level EPCF via a single stab incision.

Method

In this study, the minimally invasive surgical method was used for two-level cervical radiculopathy, and useful information regarding perioperative care was presented.

Conclusion

EPCF is an alternative treatment for patients with symptoms of adjacent two-level lesions of the cervical spine, and such procedure is advantageous as it can be performed with a small access.

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Funding

This study was funded by the Project of Jiangsu Province Health and Family Planning Commission (2016 BJ16026), Foundation for Leading Talent in Traditional Chinese Medicine of Jiangsu Province (2018 SLJ0210), and Social Development Project of Jiangsu Province (2019 BE2019765).

Author information

Authors and Affiliations

  1. Department of Spine Surgery, Third Clinical Medical College of Nanjing University of Chinese Medicine, 100th Shizi Street, Nanjing, 210028, Jiangsu Province, People’s Republic of China

    Zhipeng Xi, Yang Lu & Lin Xie

  2. Department of Orthopedic Surgery, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, 100th Shizi Street, Nanjing, 210028, Jiangsu Province, People’s Republic of China

    Zhipeng Xi, Yang Lu & Lin Xie

Authors
  1. Zhipeng Xi
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  2. Yang Lu
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  3. Lin Xie
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Corresponding author

Correspondence to Lin Xie.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Additional information

Key points

1. Two-level EPCF can be performed via a single stab incision due to the smaller cervical vertebra and pivoting ability of the endoscope and working channel.

2. The pathologic lesion should be identified via various examinations.

3. The procedure has a steep learning curve; thus, particularly in beginner surgeons, orientation through the endoscope can be challenging. The V-point is the most common important reference point in surgery. In addition, a sheath with a larger radius may make the orientation difficult, and minimal movement of the sheath may lead to large deflection under endoscopic view, particularly when validating the site` of the two-level lesion. Thus, the use of a smaller endoscope or the modified location technique [3] during surgery is recommended.

4. Facet joint removal should be less than 50% to prevent procedure-induced segmental instability.

5. The two most commonly involved adjacent nerve roots are C5 and C6 as well as C6 and C7. Thus, the lower lamina is commonly drilled according to the course of the nerve roots.

6. It is better to remove the LF after the interlaminar windows of both levels are enlarged.

7. If the herniated nucleus pulposus cannot be found, injection of methylene blue into the disc using an 18-gage spinal needle can help identify the target.

8. After a successful surgery, the resected specimen should match the expected amount based on MRI, and the exiting nerve root should feel free when palpated with a nerve hook.

9. The nerve should not be pulled beyond its limitations to prevent nerve injury.

10. If general anesthesia is used, nerve electrophysiology monitoring should be considered during surgery, which may reduce the incidence of nerve root injury.

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Xi, Z., Lu, Y. & Xie, L. Endoscopic posterior cervical foraminotomy via a single stab incision for contiguous two-level cervical radiculopathy. Acta Neurochir 162, 685–689 (2020). https://doi.org/10.1007/s00701-019-04198-4

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  • DOI: https://doi.org/10.1007/s00701-019-04198-4

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